Gonal or clostilbegit which is more effective. Ovulation stimulation schemes. How to use drugs

There are quite a lot of drugs that stimulate ovulation, but only a specialist can choose the right one and describe the regimen for its administration. Getting drug therapy is only half the battle. It is important to monitor the growth of follicles and try to conceive a child in time. In this article, we will look at how to properly stimulate ovulation with Clostilbegit, Duphaston, Gonal-F, Letrozole, Menopur, Puregon, Femara, and others. However, such treatment requires prior medical consultation.

What if ovulation is irregular or does not occur at all? You can create it artificially by taking Klostilbegit. It is also prescribed for, as well as in cases where pregnancy does not occur for a long time for unknown reasons. This drug, among other things, increases the concentration of prolactin.

The action of Clostilbegit is aimed at increasing the level of hormones that stimulate the ovaries and contribute to the onset of ovulation. Its active substance triggers the production of hormones by the pituitary gland. The duration of therapy is five days. To restore fertility, as a rule, 1-2 stimulated cycles are enough.

Unfortunately, Clostilbegit stimulation is allowed to be done 5-6 times throughout life. This is due to the fact that its active substance, if used irrationally, can provoke the strongest. It should be borne in mind that against the background of taking the medication, there is late ovulation.

Klostilbegit is a drug, the stimulation of ovulation which often leads to such an undesirable phenomenon as a deterioration in the growth of the endometrium. That is, it may happen that conception occurs, but the implantation of the embryo will be impossible. For this reason, while taking the medication, it is necessary to monitor the condition of the endometrium.

Click to enlarge

Scheme of application of Clostilbegit

How to stimulate ovulation with Klimofen (Klostilbegit)? The drug is taken from the fifth to the ninth days of the cycle. The dosage is calculated individually, and is determined by the patient's body weight and the characteristics of her menstrual cycle. On the first or second day of using the drug, a woman needs to undergo an ultrasound examination. This will track the development of follicles and the thickness of the endometrium. If positive dynamics is not found, then you will need to take medications containing estrogen.

The results of Clostilbegit stimulation are monitored throughout the entire period of therapy. If there is no effect, the issue of re-using the drug is decided, while the dosage is increased. In medical practice, the dosage options listed below are commonly used:

the maximum dose per day at the first stage of therapy is 150 mg;
with polycystic ovary syndrome - 50 mg per day;
in the case of depleted ovaries - 100 mg per day in combination with estrogens.

To prevent the formation of an epididymal cyst when using the ovulation stimulation scheme with Clomiphene or Clostilbegit, an injection of hCG can be used. After the injection, it is usually possible to get natural ovulation within 1-2 days. If pregnancy has occurred, then injecting progesterone is most often recommended to the patient to maintain function.

The combination of Klostilbegit and Proginov for stimulation

Therapy with Klostilbegit, according to the decision of the doctor, is supplemented by taking Proginova. The composition of the last medication includes the hormone estrogen. Proginova must be taken from days 5 to 21 of the cycle. This will establish a hormonal balance and prevent the rapid depletion of the appendages due to the use of Clostilbegit.

Stimulation of ovulation with Puregon

This drug is used to activate the maturation of the egg if you plan to conceive naturally or through IVF. The mechanism of action of Puregon is to enhance the production of sex hormones by the pituitary gland and ensure the release of the egg from the ovary.

Menogon (analogue - Menopur) to stimulate ovulation

In the process of taking the drug, the hormones FSH and LH are produced, and the level of estrogen in the blood also increases. In addition, Menogon stimulates the growth of follicles in the appendages, and also builds up the endometrium. As a rule, this medication is taken from the second day of the cycle for 1.5 weeks. Stimulation by Menopur is based on the same principles as Menogon, since these drugs have the same active ingredient in their composition.

Stimulation of ovulation by Gonalom-F

Gonal-F is one of the most powerful drugs for stimulation and is used in its absence, PCOS and other indications. It is prescribed during IVF, which allows you to get several mature follicles at once. Gonal-F is produced in the form of syringe pens and powder ampoules, which must be diluted with saline before use. The dosage is determined by a specialist. The standard scheme for stimulating ovulation with a drug is as follows:

the first week of the cycle - the daily norm is 75-150 IU;
the second week - the dosage is the same as in the first week;
third week: in the absence of own ovulation to stimulate it, the daily dosage is increased by about 37.5-75 IU.

The maximum dose of Gonal-F should not exceed 255 IU. Otherwise, the ovaries may develop with the subsequent appearance of cysts and even rupture of the appendage. The total duration of therapy is 28-30 days. During this period, the effectiveness of the drug administration is monitored by ultrasound and, at the discretion of the doctor, an hCG injection is prescribed. After the release of the egg from the ovary, the woman is usually recommended the introduction of progesterone.

Other drugs to stimulate ovulation: Duphaston, Letrozole, Actovegin, Dexamethasone

Duphaston

Duphaston is not used to stimulate ovulation, however, its use in courses by some patients can improve hormonal levels and become pregnant. This drug is an artificial progesterone. According to the instructions, Duphaston is taken 1 tablet 2 times a day (preferably at the same time) for infertility - from 14 to 25 days of the cycle, and for irregular periods - from 11 to 25 days of the cycle. Gynecologists often recommend drinking 1 tablet of Duphaston 2 times a day from 16 to 25 days of the cycle.

Letrozole

Stimulation with Letrozole (Femara), in contrast to similar therapy with Clostilbegit, gives a less pronounced antiestrogenic effect. Femara is taken from the third day of the menstrual cycle for five days. The dosages of the drug are different. Most experts recommend drinking 2.5 mg per day, others - 5 mg per day. Stimulation with Letrozole is especially appropriate if Clostilbegit is ineffective or if there are contraindications for therapy with this drug.

Actovegin

Actovegin is a drug that improves tissue metabolism. Sometimes it is prescribed in complex stimulation therapy and contributes to a successful pregnancy even in the natural cycle. The use of this medication normalizes blood circulation in the tissues of the uterus, which leads to intensive growth of the endometrium and increases the likelihood of conception.

Dexamethasone

Dexamethasone is actually a glucocorticosteroid and is recommended for the treatment of allergic diseases. In gynecology, when stimulating ovulation, it is used if the patient has adrenal hyperandrogenism. In this case, the dosage of the drug is from 0.125 mg to 0.5 mg. Along the way, 17KS of urine or 17OP and DEA in the blood are necessarily controlled. In combination with Dexamethasone, it is necessary to take medications that improve tissue metabolism, or vitamin and mineral complexes for pregnant women with the obligatory content of folic acid.

If pregnancy does not occur for two or three cycles, then Klimofen or Klostilbegit is stimulated at a dosage of 50 mg from the fifth to the ninth days of the cycle simultaneously with Dexamethasone. After the successful conception of a child, if the patient suffers from increased production of androgens by the adrenal cortex, the use of the drug continues at a dose selected individually (usually not more than 0.5 mg).

Before proceeding with the stimulation of ovulation, it is necessary to examine the woman's sexual partner for infertility. A comprehensive study of the problem of a woman's insufficient fertility should be organized and her state of health should also be assessed. This will reduce the likelihood of side effects when using drugs.

According to statistics, 35% of women become pregnant in the first or third cycle of ovulation stimulation. An important nuance: it is imperative to exclude other possible causes of the absence of pregnancy: tubal factor, poor sperm quality, dysfunction of the pituitary gland and thyroid gland. In this case, the absence of ovulation for 3 or more cycles in a row (ultrasound or hormone tests) must be accurately established. Preparations based on Clomiphene and gonadotropins stimulate the maturation of the follicle up to 18-24 mm, and hCG injections cause ovulation (rupture of the follicle).

When are hormonal stimulation drugs prescribed?

Ovulation (exit from a mature egg follicle ready for fertilization) - usually occurs 14 days before the onset of menstruation (from 12 to 16). If within 24 hours the sperm fertilizes the released egg, the desired pregnancy occurs.

Attention(!) For various reasons, the menstrual cycle may not be accompanied by ovulation - usually no more than 2-3 times a year. This is normal - the ovaries are resting. With age, the tendency to anovulation increases. In women closer to 40 years, the periods between possible days of natural conception can be several months.

According to gynecologists and reproductologists, in many cases, an effective solution to the problem is the induction of ovulation - drug stimulation of egg maturation. Drugs with follicle-stimulating or luteinizing (supporting egg development) hormones help to achieve the goal:

Horagon;
Clostilbegit;
Gonal;
Pregnil and others.

A special place is occupied by drugs based on hCG (human chorionic gonadotropin). This is a hormone produced by the female body during the fertilization of the egg and the formation of the fetus. The level of hCG plays a major role in pregnancy testing.

Stimulation of ovulation with Klostilbegit

Under influence Clostilbegit (Clomiphene, Clostil, Clomid) the pituitary and hypothalamus increase hormone production. As a result, the activity of the ovaries is activated. The medicine is made in the form of tablets.

Usually, ovulation stimulation with Clostilbegit is carried out according to the schemes:

Reception once a day 50 mg of the drug for 5 days, starting from the 2nd-5th day of the menstrual cycle. On the 11-15th day, ovulation should occur.
In the absence of the expected result, the regimen is repeated, but the single dose of the drug is increased to 100 mg. If the ultrasound confirms the success of the procedure, the pills are immediately stopped. In case of failure, the second scheme can be repeated after 3 months. The maximum total dose of the drug for one course is 750 mg.

To make artificial ovulation more effective, Clostilbegit is often combined with an hCG injection as soon as one of the follicles reaches 23-24 mm.

A very detailed article about the nuances of taking Clostilbegit and the onset of ovulation.

How to stimulate ovulation with Gonal

Gonal- a powerful hormonal stimulant, its main active ingredient is follitropin alfa, which stimulates folliculogenesis. The drug is intended for subcutaneous administration, is produced in the form of a powder for an injection solution and a ready-to-use syringe pen with a dispenser.

Stimulation of ovulation with Gonal is effective when you start taking the drug in the first 7 days of the menstrual cycle.

Usually, treatment is carried out for 28-30 days according to the scheme:

the first and second week of the menstrual cycle - from 75 to 150 IU of Gonal daily;

from the third week, the daily dose is increased by 37.5 - 75 IU, but it should not exceed 225 IU.

When prescribed during treatment with Gonal injections of the drug Pregnil, ovulation occurs in 75% of cases. Instead of Pregnyl, the doctor may prescribe other drugs based on hCG.

You can read more about Gonalom-f stimulation at.

When does ovulation occur after an hCG injection?

When solving the individual problem of the lack of ovulation, a woman is usually prescribed intramuscular injections (in the buttock or abdomen) of one of the gonadotropin preparations:

Choriogonin;
Horagon;
Menogon;
Ovitrelle;
Pregnil and others.

This procedure is necessarily preceded by folliculometry (ultrasound monitoring of the condition of the ovaries). Follicle growth is monitored at different periods, from the second to the ninth DC (depending on its length), and stimulation is carried out at the moment when they increase to 18-24 mm.

The standard dose of the drug is 5000-10000 IU. If the first injection of hCG with ovulation stimulation at the minimum dosage (5000 IU) did not give the expected result, the procedure may be repeated in the next cycle, but with the introduction of 10,000 IU of the drug.

As a rule, ovulation after an hCG injection occurs within 24-36 hours. But under the influence of individual factors, it may be delayed or absent. Ultrasound allows you to accurately fix the time when ovulation occurs after an hCG injection. It is carried out on the third or fourth day after the injection.

If the dose does not work, the next time it is increased.

Stimulation of ovulation in polycystic ovaries - features of therapy

Ovulation stimulation for polycystic ovaries (PCOS) is one of the effective ways to get pregnant. The disease is a consequence of a violation of metabolic processes in the ovarian membrane, due to which it thickens. For this reason, mature eggs cannot come out. In place of their accumulation, a cyst forms over time.

The issue of ovulation stimulation is solved by therapeutic and surgical methods. But here you need to be very careful and regularly monitor the volume of the ovaries on ultrasound.

In the first case, the treatment is carried out according to the following scheme:

Reception of Clomiphene from the third day of the menstrual cycle (daily rate of 50-100 mg) for 5 days. The drug stimulates the synthesis of hormones necessary for ovulation.
On the 10-12th day of the cycle, an ultrasound is performed to analyze the dynamics of follicle growth. In case of lag in the growth of the endometrium, Proginova or Divigel is connected.
If readiness for ovulation is obvious, an hCG injection is prescribed. Ovulation should occur within a day after the procedure. The day of the hCG injection and two days after it is the optimal period for conception.
From the 15th day of the cycle, hormonal support is carried out with drugs based on Progesterone.

If necessary, hormone stimulation is allowed for three menstrual cycles.

Surgically, the problem with the ovaries is eliminated with the help of laparoscopy. This is a minimally invasive method, without large and coarse sutures. In the future, hormonal therapy is carried out to maintain their own ovulation.

From experience(!) Ovulation after laparoscopy can occur already during the next menstrual cycle (for example, during laparoscopy, my ovaries were burned - diathermopuncture, after which I started my own ovulation and became pregnant on the fifth cycle).

Stimulation of ovulation with folk remedies

The traditional stimulation of ovulation with folk remedies, as a rule, consists in the use of decoctions sage, upland uterus("herbs for 40 diseases"), red brush, roses. In each case, one cooking recipe is used - 1 tbsp. l. vegetable raw materials pour 200 ml of boiling water and insist 15 minutes in a water bath.

An example of an ovulation stimulation scheme with medicinal plants:

First use sage for ovulation, which positively affects the body of the uterus and the process of egg maturation. A vegetable decoction is prepared every day and drunk 3-4 times;
in the second half of the cycle, the brewed boron uterus is used in the same way. It is believed that parallel treatment with a decoction of red brush leaves enhances the effect.

Attention(!) It is not recommended to prescribe hormonal herbs, such as a hog uterus and a red brush, on your own - this can cause a serious hormonal failure.

The healing properties of rose petals (white and pink inflorescences are used) are based on their high content of vitamin E - a stimulant of reproductive function.

Fragrant broth take 1 tsp. every night before bed. To stimulate ovulation with the help of mumiyo, it is diluted with quince, sea buckthorn or carrot juice (proportion 1:20). You need to drink a cocktail on an empty stomach, in the morning and in the evening.

It is impossible to predict exactly when ovulation will occur after stimulation with folk remedies.

What else is used to restore ovulation

Vitamin and aromatherapy can also positively affect the process of conception. A diet saturated with substances useful for the body of the expectant mother increases the effectiveness of any method of stimulating ovulation.

Aromatherapists recommend inhaling cypress, anise, sage, or basil oil. These odors increase the production of the female hormone estrogen. It is also worth taking baths with 3-5 drops of lavender or rose geranium oil. Aromas help normalize hormonal levels.

Notify me of new articles!

Expert site

Obstetrician-gynecologist Olga Pryadukhina

Obstetrician-gynecologist, doctor of ultrasound diagnostics.
Certified operating doctor obstetrician-gynecologist.
Book author :"How to Get Pregnant Fast"
Participant in research studies related to pregnancy complications. Has a number of publications in scientific journals.

youtube-channel of Olga Pryadukhina

One of the main methods of infertility treatment is drug stimulation of ovulation, the task of which is to ensure the growth and maturation of follicles to a preovulatory state. Subsequently, drugs are introduced that are the starting factor for the processes of final maturation of the oocyte and ovulation.

Artificial stimulation of ovulation in general terms

To date, many causes of infertility have been identified and continue to be clarified, options for achieving pregnancy are being developed and improved, both through controlled induction of ovulation processes and with the help of modern reproduction technologies in programs of various in vitro fertilization methods.

Stimulation of ovulation is necessary in cases where the cause of infertility is the absence of a mature egg from the ovary (), mainly if present. The latter is a polyetiological endocrine disorder caused by both hereditary causative factors and environmental factors.

Polycystic ovary syndrome is manifested by polycystic ovarian morphology, ovulatory and/or menstrual dysfunction, and symptoms of hyperandrogenism. Stimulation is carried out only after examination and exclusion of other factors of infertility, such as male and.

Controlled induction of the ovulatory process, the main drug in the scheme of which is Clomiphene citrate, or Clostilbegit (ovulation stimulation pills), can result in conception naturally, intrauterine administration of sperm () or collection of follicles through transvaginal puncture for further artificial in vitro fertilization (IVF) of oocytes . At the same time, drugs for stimulating ovulation during IVF are used basically the same as for those for the purpose of natural (or by artificial insemination) conception.

The feasibility of using traditional medicine

The literature on traditional medicine, many Internet sites and even some gynecologists give advice on dealing with infertility, which suggests the stimulation of ovulation with folk remedies.

In folk medicine, even before the development of scientifically proven methods of combating infertility, there were recommendations on the use of certain medicinal herbs and fees for this purpose, special gynecological massage, etc. The preparation of such recipes was purely empirical and did not take into account the causes of infertility.

And at present, for these purposes, for example, an extract of Tribulus terrestris, decoctions and infusions of sage, pine forest, rose petals, decoctions of Adam's root, plantain seeds, four-membered radiola leaves, knotweed grass, a mixture of aloe pulp with melted butter and honey, etc. .

Folk methods also recommend vitamins, mainly “E” and “C”, ready-made vitamin complexes with macro- and microelements, infusions of medicinal plants containing vitamins, aromatic baths or abdominal massages with essential oils of lavender, sage, cypress, basil, anise, sandalwood wood, roses, etc.

Some ovulation inducing herbs contain substances that may have some effect on infertility. However, most often the mechanism of action and the points of application in the body of the active ingredients contained in them have not been studied enough, and their dosage has not been determined.

The apparent effectiveness of their application in some cases is usually associated with chance. So, for example, if ovulation stimulation was performed with multifocal ovaries, which were erroneously diagnosed as polycystic.

Multifocal, or multifollicular, ovaries can be detected by ultrasound and represent one of the normal sonographic variants in the natural cycle on the 5th to 7th day of the menstrual period. They have a significant echographic similarity with polycystic ovaries, but differ in the normal size of the latter and a much smaller number (usually no more than 7-8) follicles.

This condition occurs with hypogonadotropic amenorrhea, and also as a physiological condition in women, especially those who take it for a long time, in girls during puberty. Often, such an echographic picture is taken for an emerging or already existing polycystic ovary syndrome and treatment is prescribed.

At the same time, multifollicular ovaries in themselves are a variant of the norm and cannot be the direct cause of infertility or menstrual irregularities. For the purposes of differential diagnosis, it is necessary to take into account the presence of general external changes (hirsutism, obesity, etc.), as well as the results of additional studies on hormones - blood levels of testosterone, luteinizing and follicle-stimulating hormones and insulin.

Drug stimulation of ovulation in polycystic ovaries

The meaning of treatment is to restore ovulatory cycles. Preparation for treatment includes an examination to exclude tubal-peritoneal and male factors as the causes of infertility. Elevated body mass and free testosterone indices, amenorrhea, enlarged ovaries are unfavorable prognostic factors for the use of the controlled induction technique.

When preparing a woman, a blood test for the content of Müller's inhibitory substance, or anti-Müllerian hormone (AMH), has a certain prognostic value. The synthesis of this hormone occurs in the granular cells of the growing follicles. It reduces their sensitivity to the influence of follicle-stimulating hormone and inhibits the growth of premordial follicles, which are a functional reserve. The latter decreases with increasing age.

AMG allows you to evaluate the functional reserve of the ovaries and decide on the advisability of ovulation stimulation, as well as differentially select and prepare women for conducting. The response of the female body to stimulation with low AMH is much worse compared to women with a normal level of this hormone.

Changing the concentration of anti-Müllerian hormone during controlled induction makes it possible to determine the degree of risk of developing hyperstimulation syndrome.

In preparation for conception, therapeutic lifestyle modifications are needed, including recommendations for a specific diet, exercise, and obesity treatment, which must be implemented before ovulation induction begins. This is due to the fact that in women with a high body mass index, androgenic hormones are produced in excess. In addition, preparation measures also include drugs such as folic acid and its derivatives, smoking cessation.

What drugs are used to stimulate ovulation?

Under the influence of one of the prescribed hormonal drugs, the growth and maturation of the dominant follicle is stimulated. Sometimes the maturation of several follicles is possible. After that, drugs are introduced that promote the release of a mature egg from the follicle and prepare the endometrium for implantation of a fertilized egg.

For these purposes, according to the developed program, the following drugs are mainly used to stimulate ovulation and prepare the endometrium:

Clostilbegit;
Letrozole;
Gonal-F or Puregon;
Human chorionic gonadotropin (hCG);
Dydrogesterone.

How is ovulation stimulated?

The selection of the program takes into account the age of the woman, her body mass index and the presence of other factors of infertility. During induction cycles, observations are made to detect the appearance of menstrual blood in women with previous amenorrhea, laboratory studies of the average increase in luteinizing hormone in the cycle, an increase in the concentration of progesterone during the expected middle phase of luteinization, ultrasound examinations, as a rule, daily, especially from the 10th day of the cycle.

All this is necessary in order to control the response of the ovaries in terms of maturation and release of the egg or pregnancy. Ovulation is stimulated at home, but with systematic outpatient monitoring and examination.

Clostilbegit (clomiphene citrate)

Clostilbegit serves as a first line remedy. The drug, the active ingredient of which is clomiphene citrate, is available in tablets of 50 mg.

The scheme of stimulation of ovulation with Klostilbegit is as follows. The drug is taken from the 2nd to the 5th day of the natural or stimulated menstrual cycle. In the case of amenorrhea, clomiphene citrate can be started on any day. Its starting daily dose is usually 50 mg, course intake - 5 days. If there is no effect, the second scheme is used, according to which the daily dosage of Clostilbegit is already 100 mg at the same course duration.

How many times can I stimulate ovulation with clomiphene citrate?

The maximum daily dose should not exceed 150 mg of the drug. Such treatment can be carried out for no more than six cycles of expected ovulation. However, as a rule, in most cases (85%), pregnancy occurs already in the first 3-4 months after clomiphene therapy.

The mechanism of action of Clostilbegit, which is the drug of choice for polycystic ovary syndrome, is due to its combination with estrogen receptors and their blocking, resulting in (as a result of positive feedback) an increased secretion of pituitary gonadotropic hormones (follicle-stimulating and luteinizing). This, in turn, causes follicular hormonal activity with subsequent formation of the luteal body and stimulation of its activity.

Unfortunately, resistance to the drug is about 30% of women, and the effectiveness of treatment with clomiphene reaches only 70-80%, and the fertilization rate per cycle is only 22%. The effectiveness is especially low among women with very low body weight.

decreased blood flow in the uterus during implantation of a fertilized egg and early luteal phase;
violation of the maturation and growth of the endometrium, which is one of the most important targets of the antiestrogenic effect;
underdevelopment of the stroma and glands of the endometrium and a decrease in the thickness of the latter;
an increase in the viscosity of cervical mucus and a decrease in its amount.

Especially these negative effects are manifested when using high dosages of the drug or its long-term use. Insufficient maturity and thickness of the uterine mucosa by the time ovulation develops during its induction with Clostilbegyt may be the cause of a low percentage of pregnancies and a high number of pregnancies.

In this regard, if pregnancy did not occur in the first four months after ovulation stimulation, further use of Clostilbegit is pointless. This procedure is stopped and the treatment tactics are changed.

Letrozole (Femara)

Letrozole was previously recommended for the treatment of postmenopausal women with breast cancer. In recent years, Letrozole for ovulation stimulation has become, along with Clostilbegit, a first-line drug and is an alternative to the latter. It is prescribed if Clostilbegit is ineffective or if there are contraindications to its use.

The drug is available in tablets of 2.5 mg. In order to induce the ovulatory process, a Letrozole therapy cycle is prescribed from the 3rd day of the menstrual cycle. The duration of admission is 5 days. Dosage regimens are different - most authors recommend dosages of 2.5 mg per day, others - 5 mg.

Letrozole is characterized by a moderate antiestrogenic effect, due to which, after taking it, an increase in the production of follicle-stimulating hormone by the pituitary gland and stimulation of the ovulatory process occur. However, compared to Clostilbegyt, its antiestrogenic effect is less profound and shorter in duration.

The drug also improves the thickness and other indicators of the state of the uterine mucosa, increases the sensitivity of the ovaries to follicle-stimulating hormone. This makes it possible to reduce the required dose of follicle-stimulating hormone administration by 3 times in induction schemes using the latter. In addition, during its administration, side effects are observed very rarely and are not pronounced.

Stimulation of ovulation by gonadotropins

In cases of resistance to clomiphene citrate or in the absence of conditions for its use, preparations of the pituitary follicle-stimulating hormone Gonal-F or Puregon are prescribed, which are available for subcutaneous or intramuscular administration. They belong to the means of controlled induction of the second line.

There are various schemes for the use of these drugs. Stimulation of ovulation with Gonal or Purigon is carried out from the first day of menstruation or the expected day of menstruation, or on the 5th - 6th day after the abolition of the oral contraceptive. Induction is carried out by seven-day cycles in the amount of not more than 6 cycles. The results of the drug administration in terms of the adequacy of the maturation of the follicles are monitored by ultrasound.

Step up, or the mode of gradual daily increase (by 40-100%). For the starting dose, 37.5-50 ME are taken. With adequate growth of follicles after a week, the initial dose of the drug in subsequent cycles remains the same. In the absence of their adequate response after seven days, the dosage of the drug in the next cycle is increased by 50%. Such a regimen for the administration of Gonal or Purigon in polycystic ovary syndrome is the most preferable, since it provides a gradual individual selection of the minimum required dose of the drug with a minimal risk of complications.
Step down, or step down mode. The program provides for high starting doses (100-150 ME) with subsequent dose reduction. This protocol is recommended for low AMH indicative of low ovarian reserve (usually in women over 35 years of age) and ovarian volume less than 8 cm3, secondary or amenorrhea, and a history of ovarian surgery. However, the use of such a stimulation regimen is limited, since it requires a long clinical experience of a specialist.

HCG to stimulate ovulation

The drug hCG has the effects of luteinizing hormone secreted by the cells of the anterior pituitary gland. It is used after ovulation induction as a trigger for the destruction of the follicle and the release of a mature egg. HCG also contributes to the transformation of the follicle into the corpus luteum, increasing the functional activity of the latter in the luteal phase of the menstrual cycle, and is involved in creating conditions for the implantation of a fertilized egg and in the development of the placenta.

Pregnil, the active ingredient of which is hCG, is available as a lyophilized powder in various doses, complete with a solvent. It is administered once intramuscularly at a dose of 5,000-10,000 IU. The conditions for its introduction, regardless of the induction scheme used, are the achievement of:

The leading follicle of the required diameter (not less than 18 mm).
The thickness of the endometrium is 8 mm or more.

Ovulation of the egg can occur from follicles with a diameter of 14 mm or more. In order to support the luteal phase, Pregnyl can be administered as a single dose of 1,500 IU every 3 days for 10 days.

The period of onset of ovulation is 36-48 hours after the administration of the drug. At this time, sexual intercourse or artificial insemination is recommended.

Dydrogesterone (Duphaston)

Synthetic dydrogesterone is available in 10 mg tablets under the trade name Duphaston. It is characterized by a selective progestogenic effect on the endometrium, which contributes to the onset of the secretory phase in the latter. In high doses, dufaston can cause suppression of the ovulatory process, but this does not happen when using normal dosages.

Duphaston, when stimulating ovulation, is used at 10-20 mg twice a day in the second phase of the menstrual cycle for at least 18 days, followed by ultrasound diagnosis of pregnancy after 3 weeks. The drug can be used in conjunction with Pregnil or alone to support the luteal phase of the ovulatory process.

Negative effects of ovulation stimulation

The main frequent negative consequences of controlled induction are ovarian enlargement, bloating, mood instability, unpleasant subjective sensations in the form of headaches, paroxysmal hot flashes.

In addition, possible (no more than 10%), intrauterine fetal death, especially with multiple pregnancies, spontaneous miscarriage, ovarian hyperstimulation syndrome.

The latter is a diverse set of symptoms that occurs in response to the sequential administration of follicle-stimulating hormone and hCG preparations. It usually develops by the second - fourth day of induction (early hyperstimulation syndrome), however, there have been cases of late syndrome (at 5 - 12 weeks of pregnancy), which is much more severe.

Depending on the severity of the course, 4 degrees of this complication are distinguished, which can be manifested by discomfort, heaviness and pain in the abdomen, repeated vomiting, diarrhea, swelling of the extremities, face and anterior abdominal wall, ascites, hydrothorax, lowering blood pressure, etc. severe cases require treatment in an intensive care unit.

Hyperstimulation syndrome is the most dangerous complication, which, fortunately, develops very rarely during natural conception and artificial insemination (less than 3-5%), unlike IVF.

Before the appointment of medicinal stimulants, the lady undergoes a full course of examination, as well as her sexual partner. It turns out the true reason for the lack of release of the egg, and only then the doctor selects ovulation stimulation schemes individual for each person.

Klostilbegit - ovulation stimulation scheme

Stimulation with hormones is prescribed to a woman if her egg does not mature, that is, there is no development of the follicle. Factors affecting conception are the age of the expectant mother, the cause and duration of infertility.

The purpose of the prescribed hormonal drugs is to help form a full-fledged germ cell capable of fertilization and further development.

A significant place in this method of infertility treatment is occupied by the ovulation stimulation scheme with clostilbegit.

This is a hormonal drug that helps the follicle grow to the desired size. Treatment begins on the 5th day of the menstrual cycle and lasts for 9 days. Ultrasound is systematically performed. The first is prescribed 2-3 days after taking the medicine, and then repeated at the same time intervals until the liquid bubble reaches 20-25 mm in diameter. The next step is the introduction of hCG to start the process of egg release itself.

If pregnancy does not occur after three courses, it is advisable to take a break in treatment and revise the regimen, it may be worth switching to another drug. More than 6 courses of treatment with clostilbegit throughout life cannot be carried out so as not to cause early menopause or ovarian hyperfunction.

Clostilbegit and proginova

Taking clostilbegit can inhibit the production of estrogen, which causes thickening of the cervical mucus, and this is an obstacle to the penetration of sperm.

To avoid such an undesirable effect, doctors often prescribe an ovulation stimulation scheme with clostilbegit and proginova.

Proginova is indicated under the following conditions:

thin endometrium;
decrease in estrogen in the blood;
with miscarriages that were before.

Proginova maintains the level of the hormone at the desired level, helps the endometrium to acquire the desired thickness and brings the cervical mucus into a state that promotes the promotion of male cells in the fallopian tubes. The drug is prescribed only by a doctor in individual doses. The course of treatment lasts from 5 to 21 days of the cycle. It should be remembered that it is impossible to take this medicine with other estrogens, so as not to get ovarian dysfunction.

Scheme of stimulation of ovulation by gonal

Often, ovulation is stimulated by gonal, the regimen of which is also individual. It is considered safer and more effective than clostilbegit.

This drug, like the follicle-stimulating hormone, regulates the menstrual cycle and ovulation, helps restore disturbed hormonal levels and the ability of the ovaries to reproduce the egg. Apply it in the first 7 days of the cycle, that is, from the day of menstruation. Further appointment is regulated by the doctor. The duration of the course depends on the size of the follicle. When it reaches 18 mm according to ultrasound, the reception is usually stopped. Stimulation can last up to two weeks, but 2-3 days before cell maturity, it stops so that after this period hCG is administered.

What vitamins are needed to stimulate ovulation

Before planning pregnancy, it is necessary to have an adequate supply of vitamins and minerals in the body. If they do not match, ovulation is stimulated with vitamins, the regimen of which depends on the period of the menstrual cycle:

The most necessary is vitamin B9 - folic acid, it stimulates the growth of the follicle and is needed for the development of the fetus.
Vitamin C improves blood circulation and boosts immunity.
Vitamin E contributes to the normal growth of the egg, so their intake is indicated already from the first phase of the cycle.
Other B vitamins are more effective after ovulation.

It is important to use potassium iodide, which is necessary for the normal development of pregnancy. It is permissible to replenish it by consuming iodized salt instead of regular salt. The doctor must also select a vitamin complex for the period of conception and pregnancy.

Among those who used the described ovulation stimulation schemes, the reviews on the results of treatment are different. Some women managed to conceive with one course of treatment, others needed more time and even an additional examination with the replacement of a stimulant drug.

In any case, if the doctor correctly established the cause of the deviation and correctly selected the ovulation stimulation scheme, pregnancy will occur at the end of treatment.

Due to the difficulties of self-conception, a woman is prescribed ovulation stimulation. Now there are no problems with the selection of effective drugs that artificially provoke the release of an egg from a ruptured follicle into the abdominal cavity. All procedures must be supervised by a gynecologist.

How is ovulation stimulated?

First, the doctor must establish the reason why the long-awaited pregnancy does not occur. To do this, studies are carried out to determine the level of hormones, as well as a series of ultrasound procedures. The first is prescribed on the 8th day of the female cycle, then the procedure is repeated every 3 days until the onset of ovulation or menstruation. The man must also undergo a series of examinations.

When the reasons for the absence of pregnancy are established, the doctor prescribes medications that stimulate ovulation, and also determines how much they should be used in time. Throughout the course of medication, a woman is regularly given an ultrasound scan to monitor the growth of the follicle. When they reach a size of 17-18 mm, ovulation becomes possible.

Ovulation inducing drugs

Drug stimulation of the onset of ovulation is carried out with the help of two hormones: follicle-stimulating and luteinizing, which are contained in a number of medicines. Usually applied:

Clostilbegit.
Puregon.
Menogon.
Gonal.

Stimulation of ovulation with clostilbegit

The drug increases the production of follicle-stimulating and luteinizing hormones, due to which the stimulation of ovulation is highly productive.

The tool is a tablet. 1-2 pieces are drunk daily, from the second day of the female cycle. Duration of reception - 9 days.

Stimulation of ovulation by gonal

Gonal injections are placed under the skin or into the muscles at the beginning of the cycle. The time of admission depends on the content of the hormone estrogen in the blood, as well as on the results of an ultrasound study.

Injections help the production of hormones that are necessary for the normal functioning of the endocrine gland. It also helps to control the stages of follicular growth, induces ovulation.

Ovulation stimulation scheme

Stimulation of ovulation with medications is carried out according to a certain scheme, in which 3 stages are distinguished.

Stage 1. Start

Drinking medicines begins on the 2nd-5th day of the female cycle, and ends after 5 days. Clostilbegit tablets are taken in an amount of 1-2 pieces daily, Gonal is given by subcutaneous or intramuscular injections once a day, and always at the same time.

Stage 2. Control of follicular growth

A week after the start of the use of drugs, ultrasound control of the maturation of the main follicle, as well as the endometrial reaction, is required. When taking Klostilbegit, ultrasound is performed on the 7-11 and 14-16 days of the female cycle, Gonal - on 6-7 and 9-11. The follicle grows to the minimum allowable size on the 13-16th day.

Stage 3. Control of ovulation

With successful ovulation within 17-19 days, a control ultrasound is done. To ensure the viability of the fertilized follicle, at the onset of 16 days from the beginning of the female cycle, progesterone intake starts. The course is a maximum of two weeks.

ovulation after stimulation

The first stimulation of the onset of ovulation often ends unsuccessfully. Only 10-15% of women get pregnant on the first try. It happens that ovulation was, but did not end with pregnancy. Then the doctor will suggest choosing other drugs or changing the dosage.

However, the procedure can be repeated, but a maximum of 5 times in a lifetime. Such a restriction is imposed, since with an increase in doses of drugs, the ovaries suffer. As a result, the woman enters the stage early.

We suggest that you familiarize yourself with the information about.